Healthcare Provider Details

I. General information

NPI: 1639088354
Provider Name (Legal Business Name): DANIEL QUESADA DAVID COTA/L
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9333 LA MESA DR
ALTA LOMA CA
91701-5805
US

IV. Provider business mailing address

14037 YORKTOWN CT
FONTANA CA
92336-3537
US

V. Phone/Fax

Practice location:
  • Phone: 909-987-2501
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number2563
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: